How Technology Helps Psychotherapists

Psychotherapy no longer has to be conducted within a therapist's office, but can be conducted online over the internet.
Marcia Wendorf

Unless you've been blessed with a life remarkably free of obstacles, you've probably either considered psychotherapy or else have availed yourself of it.

Sitting down with a therapist in their office, so-called "face-to-face therapy," requires an investment on both a therapist's part, and that of the patient. An appointment requires that both travel to it, that both invest an hour of their time (or the famous 50-minute hour), and the therapist must pay for the location, furniture and keeping the lights on.

Some patients are unable to make this investment because they live in a rural area with few available therapists, they are physically unable to travel due to illness or infirmity, they fear the stigma of being seen going to therapy, or they simply don't have the time due to commitments to work, school, and family.

The Shrink is In

Enter virtual therapy. Virtual therapy, or telehealth, has been used in web based cognitive behavioral therapy (CBT) treatment of post-traumatic stress disorder (PTSD), web based treatment of depression, anxiety, and the symptoms of PTSD, and CBT for social phobia.

The U.S. Defense Department's TRICARE program is the health care program for uniformed service members, retirees, and their families around the world. Using the internet, TRICARE health care beneficiaries can to speak "face-to-face" with mental-health counselors around the clock, and from anywhere in the United States.

Organizations such as the U.S. Department of Veterans Affairs' National Center for Posttraumatic Stress Disorder and the U.S. Department of Defense's Defense Health Agency Connected Health are rolling out smartphone apps such as "PTSD Coach" and "Breathe2Relax". They are designed to help sufferers of combat trauma treat their symptoms, and learn important coping skills.

Some potential benefits of virtual therapy are the ability to continue a client's treatment when they are out of town for work or on vacation.

Virtual therapy does, however, have its downsides. While a therapist may be able to see his or her patient through a web cam, they may not be able to see the patient's body language, and this language often conveys important information about a patient's thoughts and emotions. Another concern about virtual therapy is whether the trust and interpersonal bonds experienced by therapists and their patients will be diminished by the lack of personal contact, and whether this will affect the outcome of the counseling.

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New Responsibilities for Therapists

Therapists can conduct a therapy session over the internet using video conferencing software, such as Skype, Facetime or Google Hangouts, but they must specify to patients what happens if there is an interruption in internet service. They must also specify how quickly they will respond to patients' electronic communications.

A virtual therapist should know the licensing laws, not only in their jurisdiction but in the jurisdiction where the client is located. Some jurisdictions require a therapist to be licensed in both jurisdictions, while others allow a therapist to obtain a temporary exemption that allows them to practice in the state where the client is located.

A virtual therapist should know the reporting requirements in a client's jurisdiction, such as the suspicion of abuse or neglect of minors and the elderly or vulnerable adults, and the mandatory reporting requirements when clients make threats to harm identifiable others (Tarasoff reporting requirements).

Virtual therapists must also familiarize themselves with the mental health resources available in a client’s local area in case they need to make a referral, or if an emergency arises.

Maintaining Confidentiality

It is vital that virtual therapists be able to guarantee a client's confidentiality. A virtual therapist must:
* Password protect all their electronic devices that contain client information, such as smartphones, tablets and laptops
* Install virus and malware protection on all their devices
* Use encryption for emails with clients or emails containing client information
* Encrypt their hard drives
* Install and activate wiping or remote disabling so that data can be erased from a device in case it is lost or stolen
* Make sure all file sharing applications are disabled
* Use security when sending or receiving health information over public Wi-Fi networks
* Thoroughly delete all health information from devices before discarding them.

Virtual therapists must also use HIPAA-compliant software for video conferencing. HIPAA stands for the Health Insurance Portability and Accountability Act, and it is a U.S. law for protecting patients' medical records and other health information that is provided to health plans, doctors, hospitals and other health care providers. Facetime calls are encrypted and are HIPAA compliant when using proper encryption.

To Friend or Not to Friend

Another potential minefield for therapists is social networks. Current clients or former clients often send friend requests to their therapist, and this can create an uncomfortable overlap between a therapist's professional and private lives. One doctor in Oakland, California, Keely Kolmes, provides her patients with a Social Media Policy that tells them up front that she will not accept friend requests from them:

"I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it."

The ideal is for patients to be able to have a productive, one-on-one relationship with their therapist, but if this is not possible, the next best option just might be on your smartphone.